Prognostication of co-morbidity clusters on hospitalisation and mortality in advanced COPD
Evans, Rachael A Greening, Neil Free, Robert Pranabashis, Haldar Steiner, Michael C Tracey, Nicole
Evans, Rachael A
Greening, Neil
Free, Robert
Pranabashis, Haldar
Steiner, Michael C
Tracey, Nicole
Abstract
Rationale: As the prevalence of multimorbidity increases, understanding the impact of isolated comorbidities in people COPD becomes increasingly challenging. A simplified model of common comorbidity patterns may improve outcome prediction and allow targeted therapy.
Objectives: To assess whether comorbidity phenotypes derived from routinely collected clinical data in people with COPD show differences in risk of hospitalisation and mortality.
Methods: Twelve clinical measures related to common comorbidities were collected during annual reviews for people with advanced COPD and k-means cluster analysis performed. Cox proportional hazards with adjustment for covariates was used to determine hospitalisation and mortality risk between clusters.
Measurements and main results: In 203 participants (age 66 ± 9 years, 60 % male, FEV1%predicted 31 ± 10 %) no comorbidity in isolation was predictive of worse admission or mortality risk. Four clusters were described: cluster A (cardiometabolic and anaemia), cluster B (malnourished and low mood), cluster C (obese, metabolic and mood disturbance) and cluster D (less comorbid). FEV1%predicted did not significantly differ between clusters. Mortality risk was higher in cluster A (HR 3.73 [95%CI 1.09-12.82] p = 0.036) and B (HR 3.91 [95%CI 1.17-13.14] p = 0.027) compared to cluster D. Time to admission was highest in cluster A (HR 2.01 [95%CI 1.11-3.63] p = 0.020). Cluster C was not associated with increased risk of mortality or hospitalisation.
Conclusions: Despite presence of advanced COPD, we report striking differences in prognosis for both mortality and hospital admissions for different co-morbidity phenotypes. Objectively assessing the multi-system nature of COPD could lead to improved prognostication and targeted therapy for patients.
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Date
2024-01-03
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James, B. D., Greening, N. J., Tracey, N., Haldar, P., Woltmann, G., Free, R. C., Steiner, M. C., Evans, R. A., & Ward, T. J. (2024). Prognostication of co-morbidity clusters on hospitalisation and mortality in advanced COPD. Respiratory medicine, 107525. Advance online publication. https://doi.org/10.1016/j.rmed.2023.107525